MEDICARE: TERRY J SCOFIELD P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	979	CO

General Provider Information

NPI Number	:	1356449094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY J SCOFIELD P.A.

Provider Business Mailing Address
First Line	:	3702 AUTOMATION WAY
Second Line	:	SUITE 103
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5737
Country	:	US
Telephone Number	:	970-224-1670
Fax Number	:	970-495-6218

Provider Business Practice Location Address
First Line	:	1107 S LEMAY AVE
Second Line	:	SUITE 200
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3960
Country	:	US
Telephone Number	:	970-484-1757
Fax Number	:	970-484-9924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/21/2014

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